Before: The ravages of winter, plus a lack of attention (oh, and age), give us the "face we deserve." — Photo by Nancy Gero, Raymond, NH

It’s my fault. They say you get the skin you earn, and in my case that’s true in spades. My skin care, up to this point, has been pretty slap-dash — as in slap on a dash of whatever’s handy or on sale.

Without beating myself up too much, this is what I see when I look closely in the mirror:

So now, at age 63, I’m on a quest to discover what I can fix (and how), what I must accept, and how do I keep from getting worse?

My first stop was to a professional for a kick-start facial. You know when you’re sick and you lose five pounds and it inspires you to keep going? I figured that if I saw some instant improvement, I’d be more likely to keep up a skin care regimen.

At Sea Spa Salon in Edgartown, aesthetician Jennifer Arena Neville discussed solutions ranging from lasers to surgery to chemical peels, but confessed that firmer skin could be mine with a facial, some home care, and a few lifestyle changes.

She tucked me into a towel-like garment, face-down on a table in a small, fragrant room and began with a massage — but not on my face. While environmental music lulled me, she expertly rubbed my back, neck, and arms, explaining that this would place me in a state of deep relaxation (it did), making my skin more receptive. She used a combination of Thai, Shiatsu, and acupressure massage that would facilitate lymphatic drainage, improve blood circulation, and release toxins. “Drink a lot of water in the next few days,” she advised, “to flush out those toxins.”

When she finished my back, she worked on the front of my neck, my upper chest, and my face. By now, I was well beyond receptive. She cleansed my face thoroughly (using more massage) and examined my skin under a bright light. She didn’t gasp, so I was encouraged. Then it was more massage with balms, toners, and an exfoliate.

Her favorite products are from the French Decleor line. They are all natural, with ingredients like basil, chamomile, flax powder, wheat germ, and juniper berry. All are all very aromatic, which added considerably to the relaxation — until, that is, the dreaded extraction of the milia.

Those white bumps, it turns out, are little plugs of sebum and dead skin cells trapped beneath the skin, and they do not, it turns out, go quietly into that good night. Remember the old movies with the comic in the dentist’s chair, arms flailing? Well, substitute a little red-haired woman for the comic and an aesthetician with perfect skin for the dentist and you get the picture. It hurt. But, Jennifer assured me, it was necessary. Using a sterile lancet, she removed about a dozen milia before the screaming got to her. Okay, I exaggerate. But she made up for it by following with a mask that smelled like the ocean and some more very, very soothing products applied gently to my angry skin.

When I left, my face was smoother, my pores appeared smaller, the circles under my eyes were gone, and the lines and crevasses were reduced. Aside from a few temporary blotchy spots where she’d mined the milia, my skin looked great. She sent me away with some more advice for maintaining the good work she’d done:

– Gently massage the skin around the eyes (and anywhere there are wrinkles and folds) using the middle finger and moisturizer to restore the color and elasticity of the skin.– Drink a lot of water (five to eight glasses a day) to keep your skin hydrated and flush out nasty toxins.– Eat foods high in fiber and anti-oxidants and cut caffeine and alcohol consumption to improve your skin from the inside out.– Exfoliate, then moisturize to keep those dastardly milia at bay.

The next day, I sought a second opinion. Yvonne Dennis-Stewart, owner/operator of the Mansion House Spa, has been practicing cosmetology on the Island for 12 years. She uses Phytomer, a mineral-based French line derived from the sea, in her custom-designed anti-aging facial. For home care, she recommends daily cleansing and moisturizing, and exfoliation once or twice a week. She explains, in her musical Jamaican accent, “We use a less abrasive cream exfoliate. Put it on in the shower, leave it for five minutes and rinse it off.”

She also stresses that drinking a lot of water, staying out of the sun and using sunscreen is the most important skin care regimen of all. The SPF, she says, refers not to the amount of protection, but to the time the protection lasts.

Elizabeth Carroll of Elizabeth Skin at the Shear Inspiration Salon in Edgartown explained the physiology of aging skin. “We shed, like cats and dogs. It falls off our arms and legs and the rest of our bodies because our clothes help exfoliate it. But on our face, the dead skin cells will build up and build up. Any new cells (born every 12 to 15 days) that try to make their way up to the surface will die off because there’s no room left on the surface of the skin.

“First and foremost,” she continues, “is to remove those dead skin cells.” Without that, no moisturizing process on the planet will work: it simply can’t make its way through.

Hormonal changes related to age are also a factor. “Our body slows down the production of collagen,” Elizabeth explains, “which is the glue in our skin that holds it all together.

“The bags under our eyes, a lot of that is dehydration. As we get older, it’s so important to keep hydrated. A lot, a lot of water.”

The dark circles under the eyes? “Believe it or not, that’s blood that leaks out of little capillaries under your eyes. Some is stress and some is dehydration. It sits there and it doesn’t go away.” She recommends brewed and cooled chamomile tea bags applied to the eyes to stimulate the old blood and flush it out.

Two new strategies Elizabeth recommended for preventing milia is to change pillowcases two or three times a week and, if we wear glasses, cleaning them daily with an antiseptic. This helps keep dead cells and bacteria from throwing long drunken parties on our skin.

“A lot of it is nutrition, too,” she concludes. “A lot of our packaged foods are full of sodium that will dehydrate us.”

That gave me another idea. My next visit was with Prudence Athearn-Levy of Vineyard Nutrition. “Skin health,” she maintains, “is a natural indication of what goes on within our bodies.”

She recommends fats. Fats! We’re so fearful, she says, we don’t get enough. “I look for people’s sources of Omega-3s and other unsaturated fats,” she says.

She recommends drinking half your ideal body weight in ounces of water per day, and more if you’re exercising.

An anti-inflammatory diet is critical, especially incorporating Vitamins A, C, E, and selenium. Find A and C in brightly colored vegetables and fruits. Vitamin E may be found in nuts, seeds, and wheat germ; selenium in seafood, whole grains, wheat germ, Brazil nuts, and eggs.

Prudence also recommends staying away from pro-inflammatory foods such as sugar, processed, packaged foods, processed fatty meats, and salt. All of that increases inflammation in the body. “When you have that inflammation,” she says, “your skin will react.”

Sheila Muldaur of Chilmark, a Certified Classical Homeopath, takes a different approach. “Homeopathic cell salts are like vitamins,” she explains. They are available at Healthy Additions in Vineyard Haven, and different ones target different skin problems. “For example, raised wrinkles, fan-shaped wrinkles, furrows, and cracked lips can all point to the salt Calc fluor.

“Homeopathic cell salts are low-potency, inexpensive, and last a long time,” she adds. Information may be found online or by consulting a homeopath.

Sheila also recommends a topical application called “7 Cream,” a combination of eight (yes, eight) natural ingredients that can be used as a moisturizer to generally condition the skin. It contains no parabens, mineral oil, lanolin, propylene glycol, or fragrances and is available online at 7cream.ca/.

Armed with all this knowledge, I’m ready to reclaim my face. It’s going to take more than the proverbial “one weird trick” the Internet touts, but since my facial, my skin is much improved, and I plan to keep it that way (or better). I’ve been paying more attention to what I put on my face and in my body. I bought a Buf Puf for exfoliating and have increased my water intake considerably. I’m using the samples provided, so I’m no longer just slopping generic sale products on my skin. I will do my best to keep the milia from forming. (Jennifer was right — it was well worth the pain to have them extracted.)

I may never again have the skin of a 20-something, but this old face is experiencing a second spring.